Q & A Vasectomy

Facts About Male SterilizationEvery year more than one-half million couples in the United States choose to have vasectomy as a form of permanent contraception. Vasectomy is a simple, safe and effective surgical procedure that blocks the flow of sperm by cutting the passageway in the upper part of the scrotum.

Because a vasectomy should be viewed as an irreversible procedure, and because it is a surgical procedure, a man and his wife should understand and weigh all the facts before making the decision for a vasectomy. Above all, their reasons for opting for a vasectomy should be clear and comfortable; they should bear in mind that sterilization should not be viewed as a solution to sexual and/or marital problems. They should be certain that they do not wish to have any more children. Each couple must consider the possibility of divorce and remarriage or the impact that the death of a child in your family may have. The advantages of a vasectomy for you should clearly outweigh any disadvantages. Prior to deciding on a vasectomy, you should also be certain that you are familiar with alternate methods of birth control, such as the condom, IUD, birth control pills, diaphragm, and tubal ligation.

Following are frequently asked questions concerning vasectomy:

Q: HOW IS A VASECTOMY DONE?A: A vasectomy is usually performed in the office. Novocain is used to prevent pain during the operation. Medicine may be given intravenously to relax you and the scrotum. Two tiny incisions are made in the upper scrotum. The vas deferens is clipped on both sides and a small portion removed; one side is sewn into a separate pocket to minimize the chance of failure. The procedure will take approximately 35 to 45 minutes. As it is unsafe to drive under the influence of premedication, you should have your wife or a friend drive you home.

Q: DOES A VASECTOMY ALWAYS MAKE A MAN STERILE?A: This operation is very close to being 100% successful. The failure rate is approximately one to two out of one thousand.

Q: MIGHT IT COME "UNDONE" IN LATER YEARS TO MAKE HIM FERTILE?A: This is virtually impossible once the scarring from surgery becomes firm.

Q: WHAT HAPPENS TO THE SPERM AFTER A VASECTOMY?A: The sperm continue to be made in the testicles but cannot travel up the tube past the site of the blockage. These sperm live, die and disintegrate in the vas deferens. The breakdown products are taken up into the blood stream. Often the body reacts to these breakdown products by producing sperm antibodies; but, to date, there are no known harmful side effects of the antibodies except those individuals who elect to have a reversal of their vasectomy. These antibodies may inactivate the sperm leading to continued infertility.

Q: WHEN WILL THE PATIENT KNOW HE IS STERILE?A: Only when there is laboratory proof of sterility is the patient considered sterile. About six weeks after the operation or after 12 ejaculations, you should call the office to arrange for a sperm count to be done. If no sperm are seen on two separate examinations, one can be satisfied that he can no longer father a child.

Q: WHAT IS THE PROCEDURE FOR A SPERM COUNT?A: A semen specimen is usually obtained via intercourse using a prophylactic rubber condom, the top of which is tied, placed in a bag or envelope, kept at near body temperature and brought to the office within an hour. Or the patient can provide a masturbated specimen in the office. The report is available the same day. The patient should call the office prior to bringing in the specimen to ensure that one of the physicians will be available to examine the semen.

Q: SHOULD CONTRACEPTION BE USED AFTER VASECTOMY HAS BEEN PERFORMED?A: Definitely. Until there is laboratory proof to sterility, the couple must continue the contraceptive method which has been best for them.

Q: CAN PREGNANCY TAKE PLACE AFTER VASECTOMY?A: After the operation and before the zero sperm count, there are live sperm stored above the operative site which must live their life cycle or be ejaculated. A couple is not liberated from pregnancy by the operation alone. It takes a zero sperm count.

Q: IS THERE MUCH PAIN DURING A VASECTOMY?A: Hardly any. The premedication given will lessen the discomfort of the tiny prick of the needle and the transient stinging of the local anesthesia. Should discomfort be felt during the procedure (this is rare), more Novocain can be given.

Q: WHAT IF I DECIDE TO HAVE MORE CHILDREN?A: Although there is a technique of rejoining the vas deferens, called a vas reanastomosis, the operation is considerably more difficult than a vasectomy and carries a much lower success rate. In other words, you certainly cannot count on this to be effective.

Q: WHY NOT LET MY WIFE HAVE A TUBAL LIGATION INSTEAD?A: This is a perfectly reasonable alternative. There are, however, several disadvantages. A vasectomy is easier, safer and less expensive. She must have a hospital stay and a more painful recovery. A general anesthetic, with its attendant hazards, is required for a tubal ligation. Although complications are rare with a tubal ligation, they are likely to be more serious than a vasectomy. It is also comforting to know, with the aid of a sperm count, that the vasectomy is successful. There is no such test available to prove the success of tubal ligation.

Q: WHAT ARE THE HAZARDS OF THE VASECTOMY OPERATION?A: AS with all surgery, even a minor operation like vasectomy carries with it the possibility of complication. A vasectomy is considered a low risk procedure, and complications do not occur very often. When they do, they are usually of minor consequence. The more common complications are:

1. BLEEDING: Discoloration of the skin near the operative site is common but of little or no consequence. Much care is taken during surgery to prevent bleeding, and the patient is instructed to take care after surgery to further prevent bleeding. If care is taken by wearing an ice pack on the scrotum, and avoiding any strain for several days, chances for internal bleeding are remote.2. INFECTION: This rarely occurs but is more likely if you have had a kidney, bladder or prostate infection in the past.3.SPERM GRANULOMA: This is a reaction of the body to sperm leaking from the vas, and may occur in between 10-15% of all vasectomies. This may occur as pain in 3-5% of vasectomies, and should be brought to the immediate attention of the doctor. Although the lump usually resolves itself, it may be necessary to block the vas off below the granuloma in rare instances.4.PAIN & DISCOMFORT: Approximately 50% of people say they have no pain following a vasectomy. The vast majority of people who do have pain can relieve their discomfort with aspirin or Tylenol, by lying down and elevating the scrotum. About one in 30 find that when they return to work after 2 days of rest, being on their feet will aggravate their discomfort to the point they have to miss work for another day or two. If one side is considerably more uncomfortable than the other, or if there is twice as much swelling on one side than the other, this should be immediately reported to the doctor.5.FAILURE OF THE VASECTOMY TO WORK: This is certainly the most disconcerting compilation and it is, fortunately, extremely rare. If this occurs, a repeat vasectomy will almost surely be successful, and will be done without further expense to the patient.

Q: ARE THER ANY LONG-TERM SIDE EFFECTS TO MY BODY?A: There is some evidence that men who have had prostate infections have a higher chance of epididymitis following a vasectomy. This is an infection near the testicle and can usually be avoided if antibiotics are administered post operatively in men with previous infections.

There is some evidence that men who have had a vasectomy have a slightly incidence of prostate cancer beginning 20 or more years after the procedure. There is no evidence of a cause and effect relationship, and most prostate cancers occur in men who have not had a vasectomy; but to date a specific explanation of this statistical finding has not been determined.